Abstract
Pseudoaneurysm is a rare cause of compressive brachial plexopathy. The authors describe a thirty-seven-year-old man with hypertension and renal disease who presented with a painful and weak left upper extremity. Examination revealed a cool extremity with absent pulses, profound weakness, and diminished sensation and reflexes restricted to the left upper limb. During emergency exploration, a thromboembolus was extracted from the subclavian artery by means of a brachial artery entrance site. A postoperative arteri ogram revealed persistent subclavian artery occlusion. On reexploration, a second throm boembolus was removed. Postoperatively, the patient regained pulses, and over several days his left upper limb strength improved.
On reevaluation several weeks later, the patient complained of greater weakness in the left arm, forearm, and hand, which was confirmed on physical examination. Nerve conduction studies and an electromyogram were interpreted as consistent with a severe left brachial plexopathy. Magnetic resonance imaging of the brachial plexus revealed a left axillary mass displacing the brachial plexus, which also manifested pulsatile flow artifact consistent with a pseudoaneurysm. A pseudoaneurysm arising from a branch of the axillary artery was surgically repaired, resulting in some return of strength.
Several cases of brachial plexopathy due to pseudoaneurysm have previously been reported, but none has been iatrogenically induced by embolectomy. A pseudoaneurysm should be considered in any patient who develops focal limb weakness after embolec tomy, particularly those receiving anticoagulation.
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